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Chemical exposure and health: Excellent science-based resource

May 24, 2010 By Leave a Comment

I recently discovered the excellent blog “New Voices for Research,” and I recommend it to you. The blog is produced by the organization Research America, a group that advocates for research on health and includes many universities and other science-based organizations. There is a section on the web site called “For the Public” which has a number of terrific resources, including a set of fact sheets demonstrating the way research saves lives and money (each sheet covers a specific health problem, ranging from suicide to pain to global health.

But back to the blog. The writers take on important issues, but do so in reader-friendly blog style. They are doing a series of posts called “Chemical Exposures and Public Health,” which so far has covered the following topics:

Part 1 – From Interest to Passion
Part 2 – An Environmental Health Risk
Part 3 – Lead: A Regulatory Success Story
Part 4 – Something My Body Needs Anyway?
Part 5 – Obesity’s Elephant: Environmental Chemicals
Part 6 – Why Our Approach to Toxicology Must Change

These posts are a good way to get people interested in this critically important topic, and one about which it is sometimes hard to find reliable information.

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: , ,

Is it okay to tinker? Evidence-based programs and “fidelity”

May 17, 2010 By 2 Comments

There is a lot to be said in favor of using evidence-based programs. They have been rigorously tested, and for that reason we can be pretty sure they will have the effects we want them to have. But often an agency or community educator will find an evidence-based program, try it out, and then want to tweak it in one way or the other. It may seem like it doesn’t quite fit your audience, or you might feel like replacing one component with something else, or skipping part of the program.

If you do that, is the program still “evidence-based?” How much can you change a program without making it less effective? The term scientists use is “fidelity” – that is, the faithfulness with which a practitioner implements a program. If you are engaging in fidelity to the program, you are implementing it pretty much as it is written, without changing its core components.

What some people do, however, is adaptation – making changes in the program to make it fit your clientele or the organization you work in. This isn’t necessarily a bad thing, and it might be necessary to fit a program into a given time frame, to accommodate people of different cultures or with different languages, or even just to have more “ownership” of the curriculum. However, if the program is changed too much, it can reduce the strength of the program. (The University of Wisconsin Extension has a helpful fact sheet that differentiates between “acceptable” and “risky” adaptation of programs.)

A recent talk given at Cornell addresses these issues in a very interesting and informative way. The wonderful Cornell Human Development Multimedia Website offers a video of Lori Rollen presenting on “Making Informed Adaptations to Evidence-based Sex and HIV Education Programs.”

(While you are there, take a look at the dozens of other videos with speakers discussing their research. It is an amazing site. I take the occasional lunch at my desk and use this site to catch up on what’s new in the world of research on human development.)

Lori helps you think out when adaptation of a program is a good idea and when it isn’t. She uses a clear “green light, yellow light, red light” system to show when it’s okay to adapt, when you should be cautious, and when it’s best to leave the program just as it is. And the programs she reviews on sex and HIV education are interesting in and of themselves.

Have you had any experience in adapting programs? We’re interested to hear from you.

Filed Under: Cornell Cooperative Extension, Evidence-Based Living Tagged With: , , ,

Local Foods: Research and policy reviewed in new resource

May 13, 2010 By Leave a Comment

I love the Ithaca Farmer’s market. It’s a regular Sunday ritual in our household to drive down to the market’s home on the shore of Cayuga Lake, listen to local musicians, have breakfast courtesy of the baked goods booth, and of course fill our re-usable bags with local produce. And we’re not the only ones: The “buy local” movement is rapidly growing nationally, based on the idea that we can reduce energy use and enjoy fresher food by purchasing items grown near our home towns.

 For those of you interested in research and evidence-based policy on this topic, I recommend to you the most recent issue of Choices Magazine, published by the Agricultural and Applied Economics Association. Unlike some other journals, Choices Magazine is available on-line, free of charge. The issue — Local Food—Perceptions, Prospects, and Policies — presents survey data, review articles, and policy analyses about local food, from a variety of perspectives.

One question taken up by several authors is: What does “local” mean, exactly? Although “local food” is typically defined along the lines of a “geographic production area that is circumscribed by boundaries and in close proximity to the consumer,” the article by Michael S. Hand and Stephen Martinez shows that consensus stops there.

I found the article by Yuko Onozaka, Gretchen Nurse, and Dawn Thilmany McFadden among the most interesting. They conducted a national survey to better understand the underlying factors that motivate consumers to buy local food. They also looked how these motivations vary among buyers living in different market venues.

Why do people buy local food? Somewhat surprisingly, they found the major motivation to be an interest in health benefits, followed by several “altruistic” reasons, like supporting the local economy and helping local farmers (see figure below).

Overall, the take-home message is that most consumers think highly of locally grown products, and there is a large and growing market for food grown close to home. And hey, it gets people like me out of the house on Sunday morning!

Filed Under: Evidence-Based Living, policy Tagged With: , , ,

Research re-imagined at USDA: New “Roadmap” published

May 12, 2010 By Leave a Comment

The venerable U. S. Department of Agriculture (USDA) has pioneered agricultural research for more than a century (see related post). Over the past several years,  the USDA has been reshaping its research priorities and funding programs, in part through the creation of the new National Institute of Food and Agriculture. NIFA has the mission to “advance knowledge for agriculture, the environment, human health and well-being” through funding research, education, and extension projects.

 USDA has just published a “Roadmap for USDA Science,” that is worthwhile reading. It calls for new approaches to foster robust food, agricultural, and natural resource science.

 The report begins in an interesting way. It asks us to:    

 Imagine a world in which…    

  …Radically improved children’s diets and nutrition slash long-term health care costs in the United States;

  …Farmers, ranchers, and forest landowners are recognized as significant contributors to large and sustainable reductions in global greenhouse gases;  

  …Farmers in sub-Saharan Africa have easy, affordable access to new seeds and animal breeds so well adapted to local conditions and so resilient to changing conditions that they feed five times as many people domestically and eliminate persistent hunger;  

  …Trends in availability of high-quality water and new options for watershed management outpace increasing demand for water even as climate change alters the geography of water resources; and

  …Technologically advanced production, processing, and foodborne pathogen detection methods make food product recalls nonexistent.  

 Farfetched, ask the authors of the Roadmap? Not at all, according to them — They believe that these goals are achievable through the kind of science the USDA will now promote. 

Among other things, the Roadmap calls for a focus on a limted number of “outcome-driven priorities,” cooperation with other agencies and institutions, concentration on both fundamental science and extension, and a “rejuvenation” of the USDA competitive grant system.

All in all, a very interesting read.

Filed Under: Cornell Cooperative Extension, Evidence-Based Living, policy Tagged With: , , ,

Drugs, Medicare, and the older consumer: Economics to the rescue

May 10, 2010 By Leave a Comment

Okay, let’s have a show of hands. First, how many of you have a relative or someone you care about who is age 65 or older? Thanks.

Now, how many of you tried to help one of these beloved relatives or friends understand and choose a plan under Medicare Part D, the prescription drug benefit for older Americans? Thanks again.

My final question: How many of you who tried to help someone understand their options under Medicare Part D sighed, wept, and eventually wanted to pound your head against the wall in an attempt to lose consciousness? I thought so.

I had this experience myself, trying to help my 80-year old mother-in-law decide which program was best for her. I’m a gerontologist, for heaven’s sake, and I tore out what little hair I have left trying to figure out what her best option was.

 To the rescue comes a highly innovative and effective translational research project, led by Cornell Professor Kosali Simon (Department of Policy Analysis and Management). An economist, Prof. Simon’s desire to apply her expertise to this real-world problem has helped people in New York and across the country make this complex and important decision.

 Medicare Part D was passed in 2003 and is the federal program that subsidizes the costs of prescription drugs for people on Medicare (the federal health insurance program for Americans 65 and over). Some people were basically going broke paying for prescription drugs, and the federal government stepped in.

It sounds good, but here’s the problem: It is extraordinarly difficult to understand the coverage. A beneficiary has to choose among dozens of plans, which include dizzying combinations of deductibles and co-payments, and use different terminology for what they cover.

 

That’s the problem Prof. Simon took on. She had spent her career studying things like the economics of state regulation of private health insurance markets for small employers. But then she did an exercise for one of her classes, and students looked at Medicare Part D. Their work led her to become interested in the topic, and she began to do research on it.

Then she got in touch with psychologist Joe Mikels (Cornell Department of Human Development), who looks at how older people make decisions. Together, they used psychological theory and experimental methods to study older persons’ perceived difficulties of choosing a plan when the number of options available under Medicare Part D is increased in a lab setting. She also studied how seniors may actually benefit from increased breadth of choice in plan offerings using econometric methods and data on plan enrollment.

But here’s where it gets really interesting. Prof. Simon saw that there was practical value in learning how to help older people to understand the differences in medication coverage between plans. She used her data to create guides that can form the basis for choosing the right plans based on examining the coverage of medications, rather than simply going by general marketing materials that were mailed to older people.

Working with Project Manager Robert Harris, an experienced pharmacist, she has expanded the reach of the program in many different ways. Based on the research evidence, they have created a variety of materials such as pocket guides to Medicare Part D, posters, counter cards for pharmacies, customized mailings to residents of nursing homes, and an email newsletter and website with thousands of hits per month. 

All of this is very nicely summarized on her project web site CURxED, which I recommend you visit not just for the information, but as a great example of how complex information can be disseminated on the web.

Prof. Simon summed up the translational research approach very well when she told me: “It is very rewarding to be able to use the same data I collect for my research in ways that are practically useful to actual human beings being served by the program I study.”

Filed Under: Cornell Cooperative Extension, Evidence-Based Living, Health and Wellness, policy Tagged With: , , , , ,

Evidence-based programming: What does it actually mean?

May 4, 2010 By 2 Comments

Anyone who loves detective novels (like I do) winds up being fascinated by evidence. I remember discovering the Sherlock Holmes stories as a teenager, reading how the great detective systematically used evidence to solve perplexing crimes. Holmes followed the scientific method, gathering together a large amount of evidence, deducing several possible explanations, and then finding the one that best fits the facts of the case. As everyone knows, often the “evidence-based” solution was very different from what common sense told theo other people involved in the case.

In our efforts to solve human problems, we also search for evidence, but the solutions rarely turn up in such neat packages. Whether it’s a solution to teen pregnancy, drug abuse, family violence, poor school performance, wasteful use of energy, or a host of other problems – we wish we had a Sherlock Holmes around to definitively tell us which solution really works.

Over the past decade, efforts have grown to systematically take the evidence into consideration when developing programs to help people overcome life’s challenges. But what does “evidence-based” really mean?

Take a look at these three options: Which one fits the criteria for an evidence-based program?

1. A person carefully reviews the literature on a social problem. Based on high-quality research, she designs a program that follows the recommendations and ideas of researchers.

2. A person creates a program to address a problem. He conducts an evaluation of the program in which participants rate their experiences in the program and their satisfaction with it, both of which are highly positive.

3. An agency creates a program to help its clients. Agency staff run the program and collect pretest and post-test data on participants and a small control group. The group who did the program had better outcomes than the control group.

If you answered “None of the above,” you are correct. Number 3 is closest, but still doesn’t quite make it. Although many people don’t realize it, the term “evidence-based program” has a very clear and specific meaning.

To be called “evidence-based,” the following things must happen:

1. The program is evaluated using an experimental design. In such a design, people are assigned randomly into the treatment group (these folks get the program) or a control group (these folks don’t). When the program is done, both groups are compared. This design helps us be more certain that the results came from the program, and not some other factor (e.g., certain types of people decided to do the program, thus biasing the results). Sometimes this true experimental design isn’t possible, and a “quasi-experimental” design is used (more on that in a later post). Importantly, the program results should be replicated in more than one study.

2. The evaluation studies are submitted to peer review by other scientists, and often are published in peer-reviewed journals. After multiple evaluations, the program is often submitted to a federal agency or another scientific organization that endorses the program as evidence-based.

3. The program is presented in a manual so that it can be implemented locally, as close as possible to the way the program was designed. This kind of “treatment fidelity” is very important to achieve the demonstrated results of the program.

As you might already be thinking, a lot of issues come up when you consider implementing an evidence-based program. On the one hand, they have one enormous advantage: The odds are that they will work. That is, you can be reasonably confident that if implemented correctly, the program will achieve the results it says it will. A big problem, on the other hand, is that a program must meet local needs, and an evidence-based program may not be available on the topic you are interested in.

We’ll come back to these issues in later posts. In the meantime, I recommend this good summary prepared by extension staff at the University of Wisconsin. In addition, I’d suggest viewing this presentation by Jutta Dutterweich from Cornell’s Family Life Development Center, on “Planning for Evidence-Based Programs. And check out our web links for some sites that register and describe evidence-based programs.

Filed Under: Evidence-Based Living, The Learning Center Tagged With: , , , ,
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